Ophthalmologist Reviewer – Incept Data Solutions, Inc – Remote

Ophthalmologist Reviewer

Qualifier:
US Citizen
Board Certified in Ophthalmology

Profile Summary:
Seeking a highly ethical, board-certified Ophthalmologist with experience performing detailed chart
reviews, preferably using the quality matrix, regulatory, utilization review, and/or payor criteria.
Summary Description:
Primarily will review peer records for compliance with the following published standards:
 Social Security Act and Code of Federal Regulation citations relating to Medicare “reasonable
and necessary” care, physician services, billing and payment, and other applicable
statutes/regulations
 Applicable National and Local Coverage Determinations

 HCPCS/CPT Codebook requirements
 Other CMS documentation and coding criteria, as applicable
Accountabilities:
 Applies his/her experience and knowledge to the documentation reviewed when determining
whether the provider’s decisions and actions (as documented in the medical record and
submitted claims) were medically reasonable (i.e., appropriate in scope and type, and met but
did not exceed the patient’s medical need) and consistent with the standards of medical
practice for an Ophthalmologist.
Qualifications:
 Education (general level if required) or specific courses
 Board Certified in Ophthalmology
Skills, Knowledge Abilities (SKA):
 Consistently meets deadlines and does so with high-quality work product
 Utilizes excellent written communication skills
 Demonstrated willingness to ask for direction when necessary
 Accepts and incorporates feedback and constructive criticism with grace
 Current or recent practice experience strongly preferred
 Prior utilization and/or regulatory review experience, inclusive of comprehensive written
findings reports, strongly preferred
 Preference given to candidates with a track record of review experience coupled with seeking
and incorporating feedback
Experience (If needed, describe kind & amount):
 At least 5 years’ adult practice experience demonstrating significant experience with the
Medicare population

Job Type: Full-time

Schedule:

• Monday to Friday

Experience:

• adult practice experience demonstrating: 5 years (Required)
• Medicare population: 5 years (Required)
• comprehensive written findings reports: 5 years (Required)
• coupled with seeking and incorporating feedback: 5 years (Required)
• HCPCS/CPT Codebook: 5 years (Required)

Work Location: Remote